Tobacco Documents Online

R1TfSH MEDICAL JOURNAL 23 SHP'CF1.tBER 1978 / ~` to the conclusion arrived-at by Hodson' afte a +r:_detailed review of the international literat re ;`.regarding the use and misuse of c or- trin er' l i th t i l a so n g a s, - 4: , methiazole in genera or obstetrics (pre-eclamptic to emia, , eclampsia). No cases of dkpende ec havr. . been reportedi among geriatric or obstetricc patients and those reported amon alcoholics (and with sufficient detailed d a available)-referred as a rule to, highlynstable per- `, sonalities. It shomld therefore estressed that~ :. the risk of~ ehlormethiazole ependenceis a " in real one whenn the drug is "misuscd (unstable) alcoholics but s ems very low when it is used in the.withdn 1 phase of alcoholics -- in the eorreet.way, an equallyy so when used . among the non-'"dep ' dence-prone" segment ~ of the popul8tion. M M GreTn • ' -Otd eoiry Getlese pital Alcolalism' p tt (Teac ing) Centre p..en, . nma Ho,p,q St P ' oNW -Lndonl .. Bradley,JJAMrd d7 no[:1977;r,77.-. ~~ a G1an, M B 6. M dka17. c, 1977; ;.10g8. ' a Hordee J Irl, 8ih Med,1 f.9 d; 1978, 1, 693: ~s Glatt, M, AJeoAe/iene--A Sectn!'Diaea,e.. t.ondoo,. Bngli' Universitirs Prr.s, 1975. '.~ Ghtt, M, Geurge, H R, and FriacA, E'P, BriN,A ic t J r l, 1~ 5, p~ 16iwnea Scandinaoiea, . Fris , E P (ed), ryc - 42,supp11192rG~ « M1N, Lcst re at.the Ylnd Int maionat /I tuee Pr e- and Trntment of Alto- N/Ho~d,lonm.ICCA YR~ Spain,ia 75. . K. nersonal eommuna 1975.uon. Briathing other people's smoke Stg,-AA recent study; 'to which there was no i reference in your leading article (12August,. p 453), shedsa.littlc more light on the possible health risks of breathing other people's smoke. Agpart of a population study in three USA towns the contribution of familiall factors,, includingg smoking, to lung function and respiratory symptoms was investigated in 376 families with 816ehildren: Neither lung ;lunction nor respiratory symptoms of a non- " smoking husband~ or wife were affected by a -smoking: spouse. Parental smoking appeared to have noeffea on children's respiratory symptoms. The ehildrenahemselves answered 'questionsabout cough and phlegm. In other studies which have shown an association between ckrildrer.'s symptomsands parem-lI smoking parents answered the questions for their offspring and this may have biased the results. Alsoin the USA population study' there was no convincing evidence that parental smoking adversely affectedd children's lung funetion. Out of five different measurements of lung function the only.signifinnt association. ' was that daughters'maximum expiratory -'ilaww rates at 50 %of forced vital capacity were lowest in families in which the mother smoked 'sndd the father was a non-smoker. The effect was small and, eouldhave been, a chance finding. Howevery smoking parentss compared with non-smokers had,s significant reduction. In forced expiratory volume in. Is and the -results for forced vital capacity.and 8owrates showed'similar trends• . - The onlydcfinite evideneee that parental smoking may affect their children's respiratory system is that infants of smoking parents have more respiratoryillncss during the firso year of life than infants of non-smoking parents; but in the.satne population thiss association was absent in children aged 1-5 years. At present there is no firm evidence that these illnesses in - children under one year have a serious and lasting effect as no excess of respiratory illness r or diminished lung function has been found in the older children of smoking parents. l.ondmn N I R S F SCHauNc AREND BOUHUYS Yale Univeraity Lung Reuarch Cenror,. New Haven, Conneaicut eSetulling, RS F, ret. Awerican Jeornolo/EPi- dnnia7ary, ,1977, 106, 274. aGolleyr J R T, Hollind..WW, and C-orkhill„R T, . Loncee, 1974, 2. 1031. Sta,-In your.leading article on this subject (12 August, p 453) you write that "small amounts of, nicotine inhaled by non-smokersarrunlikely to have any medical importancel' In aa recent, publication in A1lergie et Immunologiet I describe an atopic dermatitis affeaingfive members of myy family whoare clinically hypersensitive to the nicotine alkaloidi ofNisoeiana tadacum.. Wee have a speciflc degranulation of the basophils (DIB test ofBenveniste')with'~the hapten ~.nicotine bound: to human serum albumin and the passive cutaneousanaphylaxis.test is strongly positive.in the rabbit. A single puff'of.tobacco smoke can induce an anaphylactic reaction of the skin--"atopic dermatitis" or "asthma of the skin" (Tuft). We are at present carrying out investigations with Professor A L.De Weck, of'.the Instimte for Clinical Immunology in Beme, the results of which will be published shortly. _ ' BER~NARD J-L SUDAN Basle, Switzerlind - S:udan, B J-L, At„y ~eel drnmuowlnpie, 1978, 10, 36. 3 Bemmiste. J. AnnaL~ medmeDr, d, Na y, 1977; ta, A9. StR,-Your leading article (12 August„p-053) explained: that two cases of lung cancer per 100 000 per year are caused byy the benz(a)- pyrene in environmental tobacco smoke,.that environmental.tobacco smoke may endanger persons with coronary heart disease, and that children of smokers have more upper respira- tory tract infections than children of non- smokers. Yett you conclude that breathing other people's tobacco smoke doesnot pose "serious risks to health." I feel certain that those two persons with lung cancer caused by environmental tobacco smoke,, those manypet'sons whose attack of angina pcetoriss was exacerbated by environmentaltobaecosmoke,l those children of smokers with upper respira- tory infections, and those thousands of persons with either pre-existingrnspiratoryg ailments or allergies to tobacco smoke would believe that tobaeco.smoke did posc.a serious risk to their health.. However, the issue is not whether tobacco smoke poses "serious"' risk to non-smokers; it is whether smokers have arighnto expose non-smokers to any risk. Tobacco smoke, unlike emissions from automobiles or factorie4, is not the produeCof a socially neces- sary activity. Finally, you state that since environmental tobacco smoke does not pose serious risks to health,non-smokers' assertion of "the right to breathe smoke-free air must be based on aesthetic considerations."' Legal considera- tions are totallyy neglectcd. At English andi American ~common law a battery is the "inten- tional, unpermittedj,offensive touching of the person of another," regardlessof's whethersueh touching causes harm to the health of a® the other. The legal harm is the offensiveness of the touching (kissing an unwilling partyy may be a battery): The touching may be.with an instrument (a rock, smoke), Your readers have social and legal as welll as medical groundss to insist on smoke-free air., SaamptcotG Massachuxtu ' ~ B[rfPV BRODY~ - Attorney su Law •: This correspondence is now closed.-Sn, BMJ. StR,-So faryour published corresponde ce on . thiss topic has not included the views those likely to benefit the most-namely, b' tnadical writers and their long-suffering secretaryf typists. Perhaps they are afraid~r put their names on record ,for reasons of odesr;• D Not being so inhibitnd, we are pre ing towriteo on behalf of the myriads , bo have spent coundess~ hours of'~ work, n adapting and readapting the style of eferences. Such a morass.of minute and co ~ icting requirements is so ridiculous as to ~e laughable and so ezpensive of time d moneyas to bca reproach to ourjoun sense ofsesponsibility., The Internatio 1 SteeringCommittce of Medierl Edi'tors~.( O.May, p 1334)desenves not merelylhanks a•7 appreciation but, wherever it might be eff ctive, wholesale support. Forinstance, thos /of us~who submit manuscripts could invari ~ ly adbpt the recommendations (~nclftding~ ny~~ subsequcnt refinements or modificati. , s). , -• Perhap the day may ~come when you, Sir, and~ yo r~ fellow' editors will find further modifi tion unnecessary. There will be little lost t much would be ~gained. R'CARLISI:E .. / . .. ~ . ~, . - . ~ J IAYEDAY Mlsdlagnosis of amoeblasls M Y MURrHY SIR,-It.was with some concern that I re d the letter from Dr T H Foley and fiis co1lea es (5 August, p 428) ~and your leading art~ e on the same subject (p379), both o which appeared to undermine public con ence in the availability of reference servi •s for the diagnosis of amoebiasis. At the invitation, of Sir Ja sHowie,. at that time Director of~ thr. ~ublicHralth Laboratory. Service, a refere e service for the diagnosiss of this potentiall ethal but curable disease was instituted t this hospital in October 1969. The •rvice has remained freelyavailable to t~c ry~ hospital and micro- biology 1abo.ratory '~ the United Kingdom and is in, fact used r larly, by the very hospital from which D Foley wriies; Of the manythousands~ o~~ requests for investigations relating to e diagnosis of~amoebiasissincethe scrvic ~was bcguni.none has ever been declined. The crvice has been listed annually, togtt r with other., diagnostic services, in the Plfl Year Bovk and Dirrcrory, copies of wh' h are available to every hospital0aboratoryt 'ughout thecountry..Judging by the ever- increasing (though weleome) demands made

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